680308.pdfBUILDING DEPARTMENT
Applicant FBI
PERMIT APPLICATION
Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
Alc-1
4::, A
_RA
'MAILING ADDRESS
V 17
/V
6PHONE NUMBER
TELF
41) AA Q /V L) S.
P R
NAME
ADDRESS
CITY
TELEPHONE NUMBER
NAM 0 VV /V S-- /Z
00; I_ p g R
0
1, t
Ayr-
14 Jpx�_Iylr) 0
ULLER I CITY LICENSE NUMBER
or
RESIDENTIAL
E]
GAS
NEW
I
LINE
DRETAINING
E]
NON-RESIDENTIAL I
El
SIGN
D
DEMOLISH
F1
WALL
EXCAVATE
PENCE
ALTER
n
OR FILL
( x Ft.)
REPAIR
E3
PRE -MOVE
INSP.
Ej
.......... ..........
swim
POOL
NUM33ER or
DWELLING
UNITS
61AP
46
I j-
�ARD
'I %
PERMIT
NUMBER 680308
LOT AREA VACANT SITE
NO
YES )1�
I BUILI)ING AREA Vj WER al
F/107US
31 It/W
KIMING, STREET R/W ....... i .... FT.
COMP. PLAN ST. R/W ............ Fr.
DEFICIENCY THIS PROPERTY
............ :57r.
FUARKS
RECKED BY
ETER SIZE I SERVICE SIZE
I CLEARANCE
CHECKED BY
K �RKS
YPE CONNECTION
VERIFIED BY
ERC. TEST
PERMIT NUMBER
EMARKS
ME Z241k--- TYPE OF 7STRUCTI
;;P11
STREET IMPROVED
[] YES NO
ECTOR REQUIRED
IYES 11.4 NO
OCCUPANCY GROUP
LAN CHECKE;D BY
Plan Cheek No ...................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUTTR NO
BEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FULL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given to correct: and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS Which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
119NATURE (OWNER OR AGENT)
DATE SIGNED
NOTE: Applicant Svbjecl to Plan Check Fee
PH 0-1107
This Perndt covers work to be done on private property ONLY.
Any comtructlon on the public domain (curbs, sidewalks, drivinvayg,
marquees, etc,) will require separate prrmission,
0
Z
Fee Receipt No.
% 10
I !tE M I ds7�o)
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
DIRECTO!R'S
A�SIGRE
FILE
I
t E
w
a